SIGMA audit of Scottish EVAR practice 2010-2014
Martin Hennessy, Nik Arestis, Collum O’Hare, Tom Gordon, Sophie Adams
16/03/2020
1 Details about all EVAR performed
- This document covers EVAR performed between 2010-01-12 and 2014-12-29 for any indication
- Abbreviations
- Greater Glasgow and Clyde: GG & C, GG&C, GGC
- Forth Valley: FV
- Lothian: Lo
- Tayside: Tay
- Lanarkshire: La
1.1 Number
- 731 EVAR are included here
1.2 Split by health board
1.3 Indication for EVAR
- Both ruptured and symptomatic aneurysms are judged by available clinical information
- “Open repair issue” is usually pseudoaneurysm formation at anastomotic sites
1.3.1 All health boards
1.3.2 Indication by health board
1.4 Gender of patients
1.4.1 All health boards
- 11.1% of EVAR have been performed in women
1.4.2 Gender by health board
- In GG & C, 13.4% of EVAR have been performed in women
- In FV, 8.3% of EVAR have been performed in women
- In Lothian, 8.1% of EVAR have been performed in women
- In Tayside, 12.5% of EVAR have been performed in women
- In Lanarkshire, 7.3% of EVAR have been performed in women
1.5 Year EVAR performed
1.5.1 All sites
1.5.2 Year by health board
1.6 Age at time of EVAR
- Boxplots are used in this section
- Here is a reminder of what a boxplot displays:
- The ‘box’ represents the interquartile range (IQR) of the data
- In other words, 50% of the patients fall between this age range
- The thick black horizontal line is the median age
- The thin black vertical lines extend to the upper and lower limits of age
- Black dots represent outliers (above or below 3 x IQR)
1.6.1 Number of EVAR by age
1.6.1.1 All health boards
1.6.2 Number by health board
1.6.3 Mean and median ages at time of EVAR
1.6.3.1 Indication for EVAR
| Indication | Median | Mean |
|---|---|---|
| Elective AAA | 75.0 | 74.0 |
| Elective CIAA | 73.0 | 73.3 |
| Symptomatic AAA | 75.0 | 74.8 |
| Limb ischaemia | 63.0 | 63.0 |
| Rupture | 79.5 | 79.2 |
| Open repair issue | 79.0 | 76.5 |
1.6.3.2 Indication by health board
| Indication | HealthBoard | Median | Mean |
|---|---|---|---|
| Elective AAA | GG & C | 75.0 | 74.3 |
| Elective AAA | FV | 74.0 | 74.0 |
| Elective AAA | Lothian | 75.0 | 74.1 |
| Elective AAA | Tayside | 76.0 | 74.5 |
| Elective AAA | Lanarkshire | 72.5 | 72.7 |
| Elective CIAA | GG & C | 73.0 | 72.5 |
| Elective CIAA | FV | 85.0 | 85.0 |
| Elective CIAA | Tayside | 74.0 | 74.6 |
| Elective CIAA | Lanarkshire | 66.5 | 66.5 |
| Symptomatic AAA | GG & C | 68.0 | 70.2 |
| Symptomatic AAA | Lothian | 75.5 | 71.8 |
| Symptomatic AAA | Tayside | 80.0 | 78.6 |
| Symptomatic AAA | Lanarkshire | 76.5 | 77.0 |
| Limb ischaemia | GG & C | 63.0 | 63.0 |
| Rupture | GG & C | 80.0 | 80.0 |
| Rupture | Lothian | 74.0 | 74.0 |
| Rupture | Tayside | 80.0 | 79.4 |
| Rupture | Lanarkshire | 78.0 | 78.0 |
| Open repair issue | GG & C | 86.0 | 81.3 |
| Open repair issue | Lothian | 80.0 | 78.6 |
| Open repair issue | Tayside | 74.5 | 73.0 |
| Open repair issue | Lanarkshire | 65.0 | 65.0 |
1.6.3.3 Gender
| Gender | Median | Mean |
|---|---|---|
| Man | 75 | 74.1 |
| Woman | 76 | 74.6 |
1.7 Stent-graft used for EVAR
1.7.1 All health boards
1.7.2 Number by health board
1.7.3 Number by year
- Only the most commonly used stent-grafts are charted
2 Details about elective EVAR performed
- The remainderof this page document covers elective EVAR performed between 2010-01-12 and 2014-12-29 for abdominal aortic aneurysms
- ie. common iliac artery aneurysms are excluded as well as symptomatic AAAs, ruptures etc.
2.1 Number
- 639 elective EVAR are included
2.2 Split by health board
2.3 Gender of patients
2.3.1 All health boards
- 11% of elective EVAR have been performed in women
2.3.2 Gender by health board
- In GG & C, 14% of elective EVAR have been performed in women
- In FV, 9.1% of elective EVAR have been performed in women
- In Lothian, 9.1% of elective EVAR have been performed in women
- In Tayside, 10.7% of elective EVAR have been performed in women
- In Lanarkshire, 7% of elective EVAR have been performed in women
2.4 Year elective EVAR performed
2.4.1 All health boards
2.4.2 Year by health board
2.5 Age at time of elective EVAR
- Boxplots are used in this section
- Here is a reminder of what a boxplot displays:
- The ‘box’ represents the interquartile range (IQR) of the data
- In other words, 50% of the patients fall between this age range
- The thick black horizontal line is the median age
- The thin black vertical lines extend to the upper and lower limits of age
- Black dots represent outliers (above or below 3 x IQR)
2.5.1 Number of elective EVAR by age
2.5.1.1 All health boards
2.5.2 Number by health board
2.5.3 Mean and median ages at time of elective EVAR
2.5.3.1 All sites
| Indication | Median | Mean |
|---|---|---|
| Elective AAA | 75 | 74 |
2.5.3.2 Split by health board
| Indication | HealthBoard | Median | Mean |
|---|---|---|---|
| Elective AAA | GG & C | 75.0 | 74.3 |
| Elective AAA | FV | 74.0 | 74.0 |
| Elective AAA | Lothian | 75.0 | 74.1 |
| Elective AAA | Tayside | 76.0 | 74.5 |
| Elective AAA | Lanarkshire | 72.5 | 72.7 |
2.5.3.3 Split by year
2.5.3.3.1 All sites
2.5.3.3.2 Split by health board
2.5.4 Boxplot of age at which elective EVAR was performed each year at each site
2.5.4.1 Gender
| Gender | Median | Mean |
|---|---|---|
| Man | 75 | 73.9 |
| Woman | 76 | 75.0 |
2.5.5 Decade of life
2.5.5.1 Number
2.5.5.2 Mean and median ages at time of elective EVAR
- Due to the small number of patients, those who were in their 6th or 10th decades at time of elective EVAR are ommitted from the following
| Decade | Median | Mean |
|---|---|---|
| 7th | 66 | 65.7 |
| 8th | 75 | 74.7 |
| 9th | 82 | 82.3 |
- These data are represented visually in in this plot:
All sites, all years
- Patients in their 7th decade skew slightly towards the upper aspect of that decade
- Patients in their 8th decade, the decade in which most elective EVARs are performed, are relatively evenly spread
- Patients in their 9th decade skew greatly towards the young ages of that decade
2.6 Stent-graft used for elective EVAR
2.6.1 All health boards
2.6.2 Number by health board
2.6.3 Number by year
- Only the most commonly used stent-grafts are charted
3 Iliac seal zone for elective EVAR
- Elective EVAR only are included, unless otherwise stated
3.1 All health boards
3.2 Iliacs by Health Board
3.3 Iliacs by gender
3.4 Left and right iliacs plotted separately
4 Limb occlusion
- This section deals with limb occlusion after EVAR
- The internal iliac artery component of an iliac branch device is not considered, only the external or common iliac arteries
- The purposefully occluded side on AUI is discounted
- For IBD, seal in EIA is assumed and so these are merged
- Elective EVAR only are included, unless otherwise stated
4.1 Number of occlusions
- Overall, 5.6% of limbs have occluded
4.2 Occlusion free survival
- 94% of limb occlusions happen within 6 years ***
4.3 Number of occlusions - left vs right
4.4 Number of occlusions - iliac seal zone
4.5 Occlusion free survival - iliac seal zone
- Occlusion rate for CIA seal = 5.3%
- Occlusion rate for EIA seal = 7.3%
4.6 Number of limb occlusions by site
| HealthBoard | Patent | Occluded | Percentage |
|---|---|---|---|
| GG & C | 476 | 46 | 8.8 |
| FV | 22 | 0 | 0.0 |
| Lothian | 190 | 2 | 1.0 |
| Tayside | 231 | 10 | 4.1 |
| Lanarkshire | 268 | 12 | 4.3 |
4.7 Limb occlusion survival by site
4.8 Number of limb occlusions by gender
4.9 Limb occlusion survival by gender
4.10 Number and percentage of limb occlusions by year
4.11 Number and percentage of limb occlusions by year and health board
4.12 Number and percentage of limb occlusions by year and device
- For this section, only select devices are presented
4.13 Device-specific limb occlusion
- 124 Endurant limbs inserted
- 7 occlusions (5.6%)
- 224 Endurant II limbs inserted
- 9 occlusions (4%)
- 381 Anaconda limbs inserted
- 41 occlusions (10.8%)
- 198 Excluder limbs inserted
- 1 occlusions (0.5%)
- 299 Zenith limbs inserted
- 12 occlusions (4%)
4.14 Number of limb occlusions by device
- The information on this chart has been displayed already above but is formatted differently here
4.15 Limb occlusion free survival by device
5 Survival
5.1 Thirty day survival
5.1.1 Thirty day survival after elective EVAR across all sites
5.1.2 Thirty day survival after elective EVAR by site
5.1.3 Thirty day survival after elective EVAR by gender
5.1.4 Thirty day survival after elective EVAR by decade of life
5.1.5 Thirty day survival after elective EVAR by access method
5.2 Five year survival
5.2.1 Five year survival after elective EVAR across all sites
5.2.2 Five year survival after elective EVAR by site
5.2.3 Five year survival after elective EVAR by gender
5.2.4 Five year survival after elective EVAR by decade of life
5.2.5 Five year survival after elective EVAR by access method
5.3 Ten year survival
5.3.1 Ten year survival after elective EVAR across all sites
5.3.2 Ten year survival after elective EVAR by site
5.3.3 Ten year survival after elective EVAR by gender
5.3.4 Ten year survival after elective EVAR by decade of life
5.4 Overall survival
5.4.1 Overall survival after elective EVAR across all sites
5.4.2 Overall survival after elective EVAR by site
5.4.3 Overall survival after elective EVAR by gender
5.4.4 Overall survival after elective EVAR by decade of life
6 Re-intervention after elective EVAR
6.1 Overall number of patients having re-intervention and number of re-interventions
6.2 Number of patients having re-intervention at each site
6.3 Number of re-interventions in patients who have a re-intervention at each site
- The above can be summarised in a table, also given the percentage of patients requiring re-intervention and the mean number of re-interventions these patients have:
| HealthBoard | Total | PtReint | Percentage | NoReints | ReintPerPt |
|---|---|---|---|---|---|
| GG & C | 265 | 54 | 20 | 89 | 1.6 |
| FV | 11 | 1 | 9 | 2 | 2.0 |
| Lothian | 99 | 19 | 19 | 32 | 1.7 |
| Tayside | 122 | 28 | 23 | 49 | 1.8 |
| Lanarkshire | 142 | 27 | 19 | 40 | 1.5 |
| Total | 639 | 129 | 20 | 212 | 1.6 |
(“PtReint” = Number of patients requiring a re-intervention, “Percentage” = Percentage of patients requiring a re-intervention after elective EVAR, “NoReints” = Number of re-interventions performed, “ReintPerPt” = Mean number of re-interventions per patient requiring at least one)
6.4 Re-intervention survival
6.4.1 Overall
- Over 95% of primary re-interventions have occurred by year 8 after EVAR ***
6.4.2 Re-intervention survival by health board
6.4.3 Re-intervention survival by aortic seal (EVAR vs FEVAR)
6.4.4 Survival after re-intervention
- Survival comparison of patients who have had a re-intervention with those who have not:
7 Access method
7.1 Access method used for elective EVAR
7.2 Access method used for elective EVAR across health boards
7.3 Access method used for elective EVAR by year
8 Anaesthesia
8.1 Anaesthesia method used for elective EVAR
8.2 Anaesthesia method used for elective EVAR across health boards
8.3 Anaesthesia method used for elective EVAR by year
8.4 Anaesthesia method used for emergency EVAR by year
